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• Clinical Articles •
The value of blood oxygen level dependent MRI in assessing treatment response and prognostic risk factors in cervical squamous cell carcinoma undergoing neoadjuvant chemotherapy
MOU Yanan  ZHANG Jing  PANG Yaxuan  WANG Qiyu  DING Zixuan  WANG Gang  YIN Liang 

Cite this article as: MOU Y N, ZHANG J, PANG Y X, et al. The value of blood oxygen level dependent MRI in assessing treatment response and prognostic risk factors in cervical squamous cell carcinoma undergoing neoadjuvant chemotherapy[J]. Chin J Magn Reson Imaging, 2026, 17(3): 60-67. DOI:10.12015/issn.1674-8034.2026.03.009.


[Abstract] Objective To investigate the value of the effective transverse relaxation rate (R2*) derived from blood oxygen level dependent magnetic resonance imaging (BOLD-MRI) in assessing the response to neoadjuvant chemotherapy (NACT) and prognostic risk factors in cervical squamous cell carcinoma.Materials and Methods This study retrospectively enrolled 64 patients with cervical squamous cell carcinoma who underwent surgery after NACT at our institution. All patients underwent BOLD-MRI before and after NACT. Tumor histopathological features, including lymph node metastasis (LNM), lymphovascular space invasion (LVSI), and depth of stromal invasion, were recorded based on postoperative pathology. According to Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1), patients were classified into a partial response (PR) group (n = 54) and a stable disease (SD) group (n = 10). Inter-observer agreement was assessed using the intra-class correlation coefficient (ICC). The Mann-Whitney U test or independent samples t-test was used to compare R2* values between groups. To evaluate the predictive value and correlation of R2* parameters with tumor histopathological features and response to NACT, binary logistic regression and Pearson or Spearman correlation analysis were employed, respectively. Furthermore, receiver operating characteristic (ROC) curves were plotted to assess the predictive performance of R2* values, and internal validation was performed using the bootstrap method.Results Both post-NACT R2* (R2*post) and the change in R2* (ΔR2*) demonstrated predictive value for LVSI, LNM, and depth of stromal invasion (all P < 0.05). Area under the ROC curve (AUC) analysis indicated that R2*post exhibited superior predictive performance compared to ΔR2*for LVSI, stromal invasion depth, and prognostic risk factors (adjusted AUCs: 0.862 vs. 0.792, 0.742 vs. 0.687, and 0.749 vs. 0.699, respectively), with optimal cutoff values of 21.44 Hz, 21.68 Hz, and 21.68 Hz, respectively. In contrast, for LNM, ΔR2*showed better predictive efficacy than R2*post (adjusted AUC: 0.792 vs. 0.738), with an optimal cutoff value of 1.145 Hz. Multivariate analysis further confirmed that R2*post was an independent predictor of LVSI, and ΔR2* was an independent predictor of LNM.Conclusions R2*post and ΔR2* may serve as potential imaging biomarkers for assessing treatment response to NACT and prognostic risk factors in cervical squamous cell carcinoma. Lower values of these parameters are associated with unfavorable clinical outcomes.
[Keywords] cervical squamous cell carcinoma；neoadjuvant chemotherapy；treatment response；magnetic resonance imaging；blood oxygen level dependent；prognosis；risk factor

MOU Yanan1   ZHANG Jing1   PANG Yaxuan1   WANG Qiyu1   DING Zixuan1   WANG Gang2   YIN Liang2*  

1 The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China

2 Department of Radiology, the First Hospital of Lanzhou University, Lanzhou 730000, China

Corresponding author: YIN L, E-mail: yinliang_ldyy@163.com

Conflicts of interest   None.

Received  2025-12-03
Accepted  2026-02-03
DOI: 10.12015/issn.1674-8034.2026.03.009
Cite this article as: MOU Y N, ZHANG J, PANG Y X, et al. The value of blood oxygen level dependent MRI in assessing treatment response and prognostic risk factors in cervical squamous cell carcinoma undergoing neoadjuvant chemotherapy[J]. Chin J Magn Reson Imaging, 2026, 17(3): 60-67. DOI:10.12015/issn.1674-8034.2026.03.009.

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